RS Medical Information/Emergency Authorization

RS Registration - Medical information and medical care

  • STUDENT MEDICAL INFORMATION

  • Date Format: MM slash DD slash YYYY
  • AUTHORIZATION FOR EMERGENCY MEDICAL CARE

  • I hereby give my permission to Congregation Ner Tamid's Religious School and the agents, officers, and servants thereof to choose and secure emergency medical treatment and for chosen doctor, hospital, or medical service to provide emergency medical care and/or surgery for my child name above. It is understood that every effort will be made to locate the parents/guardian, or one of the emergency contacts listed on this form before any treatment is sought. I agree to cover any expense incurred by such treatment.
  • Date Format: MM slash DD slash YYYY